(a) Except as
provided in (b) of this section, a person eligible for Medicaid under 7 AAC 100
shall pay the following cost-sharing amounts:
(1) $50 per day up to a maximum of $200 per
discharge for inpatient hospital services;
(2) five percent of allowable charges for
outpatient hospital services;
(3)
$3 per day for physician services;
(4) for a covered outpatient drug described
in 7 AAC 120.110(b),
$0.50 for each prescription that is filled or refilled with a payment for
service of $50 or less, or $3.50 for each prescription that is filled or
refilled with a payment for service of greater than $50; however, a
cost-sharing amount is not required for
(A) a
prescription for a covered outpatient drug for a recipient eligible under
7
AAC 48.560 (chronic and acute medical assistance;
limited reimbursement for prescribed drugs and medical supplies); or
(B) a vaccine administered by a pharmacist
under 7 AAC
120.110(d).
(b) The following services are not
subject to recipient cost-sharing requirements under this section:
(1) a service provided to a recipient under
18 years of age at the time of delivery of the service;
(2) a service provided to a recipient in a
long-term care facility;
(3) a
service provided to a pregnant woman, including a service provided to a woman
during the postpartum period under
7
AAC 100.304;
(4) a family planning service or
supply;
(5) an emergency
service;
(6) a hospice care
service;
(7) a service provided to
an American Indian or an Alaska Native by a tribal health program;
(8) a service provided to an individual who
is eligible for both Medicaid and Medicare, if Medicare is the primary payer
for that service;
(9) adult
preventive and screening services under
7
AAC 110.800.
(c) A provider shall collect the amount of
cost-sharing from the recipient and otherwise comply with
AS
47.07.042(a) concerning
cost-sharing.
(d) The department
will reduce payment to the provider by the amount of cost-sharing required
under this section for the service provided to that recipient.
(e) In this section, "emergency service"
means
(1) inpatient hospital care provided to
a recipient admitted into the hospital from the emergency room of that
hospital; and
(2) outpatient
hospital services and physician services provided to a recipient in response to
the sudden and unexpected onset of an illness or accidental injury that
requires immediate medical attention to safeguard the recipient's life; in this
paragraph "immediate medical attention" means medical care that the department
determines cannot be delayed for 24 hours or more after the onset of the
illness or occurrence of the accidental injury.
